estimate my costs

Estimate My Costs

What you pay out of your own pocket for health care can add up, and the marketplace plan you choose will affect how much you may have to spend over the year. Estimate My Costs will help you learn about the different types of marketplace plans in your state and how to pick one that meets your needs. After you fill in the information below, you will see a report with a How-To Guide explaining the results in both English and Spanish. Después de llenar la información abajo, verá un informe con una guía de cómo explicar los resultados en inglés y español.

My Information

The basic information you enter about you and your household allows this tool to create a cost report just for you. The report will include information about possible federal financial assistance.

Medical Services

Expected Use in the Coming Year

Think about your health and how often you visit a doctor or the hospital. Enter the number of times you think you will use each of these services next year. Sometimes people have unexpected health care needs, like a serious accident. You can use this tool again to enter different information and see how your costs could change.

Primary Care Visits

Primary Care Visits

Specialist Care Visits

Specialist Care Visits

Mental Health Care Visits

Mental Health Care Visits

Emergency Room Visits

Emergency Room Visits

Overnight Hospitalizations with Surgery

Overnight Hospitalizations with Surgery

Overnight Hospitalizations without Surgery

Overnight Hospitalizations without Surgery

Simple Outpatient Surgeries

Simple Outpatient Surgeries

Complex Outpatient Surgeries

Complex Outpatient Surgeries

Prescription Drugs

Expected Use in the Coming Year

Enter all of the prescription drugs that you take now and expect to take in the coming year. Include both the drugs that you take on a regular basis and those that you take from time to time, as needed.

Medication

Quantity

Number of pills you get each time you refill this prescription

Number of packages, such as tube, bottle, or vial, you get each time you refill this prescription

Before picking a family health insurance plan, you need to estimate all of your family’s health care expenses.

First, think about the ages and health needs of everyone in your household. Use Estimate My Costs for each family member to understand what type of plan would be best for him or her. A good way to estimate the premium for family plans is to add together the premiums that you pick from Estimate My Costs for each family member. Keep in mind that this total may be a little bit high. Some health plans may have discounts on family plan premiums. It also may be less expensive for someone with higher health costs to have his or her own health plan, instead of being on the same plan with the other family members.

Next, it is important to understand the different health plans offered in your state, their monthly premiums, and how much you might have to spend out-of-pocket for other costs, such as deductibles, copays, and coinsurance. Most family health insurance plans have both individual and family deductibles. Family deductibles are usually twice as high as the deductible for each individual in the same family plan. The out-of-pocket costs for any family member covered by the plan are applied to the family’s total deductible.

Finally, each year the federal government sets the maximum out-of-pocket limits for individuals and families. The maximum out-of-pocket limit for family plans in 2015 must not be more than $13,200. After a family reaches the maximum out-of-pocket limit, their health plan will cover the full cost of covered services for all members of the family. Each individual member of a family plan cannot spend more than $6,600 in out-of-pocket costs in a year.

Insurance costs have been a huge financial burden for us because my husband’s employer doesn’t pay for family member premiums. When we registered with the New York State ACA marketplace, we were thrilled to find out that our son, who suffers from hydrocephalus, qualified for Child Health Plus. It costs only $60 a month, requires no co-pays and covers all of his medical needs. More importantly, his pediatrician and neurosurgeon accept this plan, and we do not have to change his doctors. We welcome being able to provide our son with the comprehensive coverage that he needs. We have more peace of mind than we have felt in a very long time, and that is priceless.

I suffer from severe psoriasis and psoriatic arthritis. I have had it going on 11 years now. Up until Obamacare no one wanted to insure me because I had a pre-existing condition. Until recently the low-income hospital that would treat people without insurance did not have a dermatologist on staff. I had to rely on general medicine doctors to treat my skin condition. I now have insurance but the deductible is very high. I guess I should not complain really. I now have health insurance, and the hospital now has a dermatologist, but I cannot get in to see the specialist for three months. Anyway, that is my story.